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. 2010 Nov;20(4):279-83.
doi: 10.4103/0971-3026.73544.

Role of magnetic resonance diffusion imaging and apparent diffusion coefficient values in the evaluation of spinal tuberculosis in Indian patients

Lalitha Palle  1 , McH Balaji Reddy, K Jagannath Reddy
Affiliations

Role of magnetic resonance diffusion imaging and apparent diffusion coefficient values in the evaluation of spinal tuberculosis in Indian patients

Lalitha Palle et al. Indian J Radiol Imaging. 2010 Nov.

Abstract

Aim: To define a range of apparent diffusion coefficient values in spinal tuberculosis and to evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient values in patients of spinal tuberculosis.

Materials and methods: This study was conducted over a period of 20 months and included 110 patients with a total of 230 vertebral bodies. The study was performed in two parts. The first part included all patients of known tuberculosis and patients with classical features of tuberculosis. The second part included patients with spinal pathology of indeterminate etiology. All the patients underwent a routine MRI examination along with diffusion sequences. The apparent diffusion coefficient (ADC) values were calculated from all the involved vertebral bodies.

Results: The mean ADC value of affected vertebrae in first part of the study was found to be 1.4 ± 0.20 × 10(-3) mm(2)/s. This ADC value was then applied to patients in the second part of study in order to determine its ability in predicting tuberculosis. This range of ADC values was significantly different from the mean ADC values of normal vertebrae and those with metastatic involvement. However, there was an overlap of ADC values in a few tuberculous vertebrae with the ADC values in metastatic vertebrae.

Conclusion: We found that DW-MRI and ADC values may help in the differentiation of spinal tuberculosis from other lesions of similar appearance. However, an overlap of ADC values was noted with those of metastatic vertebrae. Therefore diffusion imaging and ADC values must always be interpreted in association with clinical history and routine MRI findings and not in isolation.

Keywords: Diffusion MRI; spine; tuberculosis.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1 (A–E)
Figure 1 (A–E)
Tuberculosis of the spine. T2W (A), T1W (B) axial MRI images in a 12-year-old girl with upper dorsal spine tuberculosis show a small prevertebral abscess (arrow). Wedging of the D2 vertebral body is seen with marrow involvement. Sagittal ADC map (C) sagittal and T2W (D) and diffusion (E) images show increased diffusion (arrow) in the involved vertebra (ADC: 1.35 × 10−3 mm2/s).
Figure 2 (A–E)
Figure 2 (A–E)
Tuberculosis of the spine. Sagittal T1W (A) and T2W (B) images in an elderly patient with tuberculosis show multifocal dorsal vertebral body involvement (arrows) with an epidural soft tissue component. Sagittal ADC map (C) and axial T2W (D) and diffusion (E) images show increased diffusion (arrows) in the involved vertebrae. (ADC: 1.42–1.5 × 10−3 mm2/s)
Figure 3 (A–C)
Figure 3 (A–C)
Tuberculosis of spine. Sagittal T1W (A) and T2W (B) images in a 40-year-old patient with spinal tuberculosis show a well-defined rounded lesion (arrow) with T1 hypointensity and T2 iso-hypointensity, which was difficult to characterize on routine MRI imaging. Sagittal ADC map (C) reveals increased diffusion in the lesion with an ADC value of 1.46 × 10−3 mm2/s
Figure 4 (A–F)
Figure 4 (A–F)
Tuberculosis initially misdiagnosed as metastasis. Parasagittal T1W (A) and sagittal T2W (B) images show a lesion with T1 and T2 hypointensity in the L1 vertebra and pedicle. Sagittal ADC map (C) reveals mild restriction of diffusion with an ADC value of 0.90 × 10−3 mm2/s. Sagittal T1W (D) and axial T2W (E) images after 6 months reveal multifocal lesions with T1 hypointensity, from D5 to D8, with a prevertebral abscess and an epidural soft tissue component. Sagittal diffusion image (F) at this time, reveals mildly bright signals in the involved dorsal vertebrae. The previously effected L1 vertebra (arrow in F) shows no significant change
Figure 5 (A, B)
Figure 5 (A, B)
Tuberculosis of the spine. Sagittal T1W image of a 35-year-old patient shows multiple vertebral body lesions (arrows) and wedging of L1, with no significant soft tissue component. It was not possible to differentiate between tuberculosis and metastases. Sagittal ADC map (B) reveals increased diffusion in the lesions, with ADC values of 1.42–1.49 × 10−3 mm2/s, suggesting that metastatic involvement was probably less likely
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References

    1. Basser PJ. Diffusion and diffusion tensor imaging. In: Atlas SW, editor. Magnetic Resonance Imaging of Brain and Spine. 3rd ed. Philadelphia: Lippincot Eilliams and Wilkins; 2002. pp. 197–212.
    1. Chan JH, Peh WC, Tsui EY, Chau LF, Cheung KK, Chan KB, et al. Acute vertebral body compression fractures: Discrimination between benign and malignant causes using apparent diffusion coefficients. Br J Radiol. 2002;75:207–14. - PubMed
    1. Baur A, Stäbler A, Brüning R, Bartl R, Krödel A, Reiser M, et al. Diffusion-weighted MR imaging of bone marrow: Differentiation of benign versus pathologic compression fractures. Radiology. 1998;207:349–56. - PubMed
    1. Spuentrup E, Buecker A, Adam G, van Vaals JJ, Guenther RW. Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol. 2001;176:351–8. - PubMed
    1. Maeda M, Sakuma H, Maier SE, Takeda K. Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by line scan diffusion-weighted imaging. AJR Am J Roentgenol. 2003;181:1203–9. - PubMed